Ranstad Karin, Midlöv Patrik, Halling Anders
Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Lund, Sweden.
Nättraby Primary Health Care Centre, Nättraby, Sweden.
BMJ Open. 2017 Jun 9;7(6):e014984. doi: 10.1136/bmjopen-2016-014984.
Socioeconomic status and geographical factors are associated with health and use of healthcare. Well-performing primary care contributes to better health and more adequate healthcare. In a primary care system based on patient's choice of practice, this choice (listing) is a key to understand the system.
To explore the relationship between population and practices in a primary care system based on listing.
Cross-sectional population-based study. Logistic regressions of the associations between active listing in primary care, income, education, distances to healthcare and geographical location, adjusting for multimorbidity, age, sex and type of primary care practice.
Population over 15 years (n=123 168) in a Swedish county, Blekinge (151 731 inhabitants), in year 2007, actively or passively listed in primary care. The proportion of actively listed was 68%.
Actively listed in primary care on 31 December 2007.
Highest ORs for active listing in the model including all factors according to income had quartile two and three with OR 0.70 (95% CI 0.69 to 0.70), and those according to education less than 9 years of education had OR 0.70 (95% CI 0.68 to 0.70). Best odds for geographical factors in the same model had municipality C with OR 0.85 (95% CI 0.85 to 0.86) for active listing. Akaike's Information Criterion (AIC) was 124 801 for a model including municipality, multimorbidity, age, sex and type of practice and including all factors gave AIC 123 934.
Higher income, shorter education, shorter distance to primary care or longer distance to hospital is associated with active listing in primary care.Multimorbidity, age, geographical location and type of primary care practice are more important to active listing in primary care than socioeconomic status and distance to healthcare.
社会经济地位和地理因素与健康及医疗保健的使用相关。运作良好的初级保健有助于改善健康状况并提供更充分的医疗保健。在基于患者选择医疗机构的初级保健系统中，这种选择（登记）是理解该系统的关键。
探讨基于登记的初级保健系统中人群与医疗机构之间的关系。
基于人群的横断面研究。对初级保健中的活跃登记、收入、教育程度、到医疗保健机构的距离和地理位置之间的关联进行逻辑回归分析，并对多种疾病、年龄、性别和初级保健机构类型进行校正。
2007年瑞典布莱金厄郡（居民151731人）15岁以上的人群（n = 123168），在初级保健中处于活跃或被动登记状态。活跃登记的比例为68%。
2007年12月31日在初级保健中处于活跃登记状态。
在包含所有因素的模型中，根据收入，处于第二和第三四分位数的人群活跃登记的最高比值比为0.70（95%可信区间0.69至0.70），根据教育程度，教育年限少于9年的人群活跃登记的比值比为0.70（95%可信区间0.68至0.70）。在同一模型中，地理因素方面，C市活跃登记的最佳比值比为0.85（95%可信区间0.85至0.86）。包含市、多种疾病、年龄、性别和机构类型的模型的赤池信息准则（AIC）为124801，包含所有因素的模型的AIC为123934。
较高收入、较短教育年限、到初级保健机构的较短距离或到医院的较长距离与在初级保健中的活跃登记相关。多种疾病、年龄、地理位置和初级保健机构类型对在初级保健中的活跃登记比社会经济地位和到医疗保健机构的距离更为重要。
